In the past seeing a psychotherapist meant delving deep into the past. We wrestled with our demons a week at a time. But that scenario is slowly changing over time. Many of today’s psychiatrists and psychologists no longer encourage their patients to linger in the past, but instead encourage them to deal with the present situations with a powerful tool – cognitive behavioral therapy, or CBT.
Dr. Stuart Eisendrath illustrates the point of CBT, saying, “If someone wants to get to Tahoe from San Francisco, you don’t necessarily need all the details of how they got to San Francisco.” Eisendrath is a professor of clinical psychiatry at Langley Porter Psychiatric Institute at the University of California – San Francisco, where cognitive therapy has been standard for several years. In other words, although advocates of cognitive therapy agree with Freud’s assertion that our childhood shapes our adult personalities, they also believe the dwelling in those formative years probably won’t help things much.
Eisendrath said, “Imagine waving to a friend, but the friend ignores you. How would you react?” He went on to say, if you’re emotionally healthy, you might just shrug it off and think they were distracted. But, Eisendrath said, someone vulnerable to depression may assume the person doesn’t want to be friends with them anymore. They might even agonize about why no one ever wanted to be their friend. What’s significant, said Eisendrath, is not the event but our interpretation of that event.
“Cognitive therapy is not about being Pollyanna and putting a positive spin on everything,” Eisendrath said, noting that people with depression may be more susceptible to rejection than the non-depressed because they may have poor social skills or be more irritable. Instead, the goal is for patients to distance themselves from their distorted beliefs and teaching them how to reshape them. “It might mean having them compile a list of evidence that they’re a good person and comparing it with a list of evidence that they’re a bad person,” said Eisendrath.
Data on cognitive therapy has been rigorously scrutinized for decades in randomized controlled clinical trials. Robert DeRubeis of the University of Pennsylvania published last year in the Archives of General Psychiatry found that 58% of moderately to severely depressed patients had a favorable response to cognitive therapy during 16 weeks of treatment. This was the same for patients on antidepressants. But when the two groups were compared one year after withdrawing from treatment, the cognitive therapy group was less likely to relapse than the antidepressant group – 31% rather versus 76%.
These findings challenged American Psychiatric Association guidelines, which state the most people with moderate to severe depression must take antidepressants. Incidentally, the association has since said DeRubeis’ study was “strong” and will be taken into consideration when the guidelines are updated.
Over 300 other clinical trials have found that cognitive therapy can be effective, either alone or in conjunction with drug therapy, in treating a wide range of ailments from phobias, addictions, anorexia, bipolar disorder, PTSD and even irritable bowel syndrome.
© Copyright 2007 Insight Journal Online Magazine.
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